Sybilla Materla

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

817084 Issued in MN

Practice address

20694 Keystone Ave Unit C
Lakeville, MN 55044-6175

Phone

(612) 323-9989

NPI assigned

Apr 13, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586736000000",
    "number": "1659990331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20694 KEYSTONE AVE UNIT C",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446175",
            "telephone_number": "612-323-9989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20694 KEYSTONE AVE UNIT C",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446175",
            "telephone_number": "612-323-9989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATERLA",
        "first_name": "SYBILLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-13",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MN",
            "license": "817084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eugene Gary Martens, M.S.E., LMFT
• Marty Chiropractic & Wellness LLC
• Jeremy Glen Marty, D.C.
• Joshua Marty, D.C.
• Hector Rene Matascastillo, MSW, LICSW, LSSW
• Trudy M Matthys, RPH
• Andrew Mattson, O.D.
• Rodney J McCutcheon, MD
• Anthony Michael McDonald, OD
• Margaret G McDonald, OD

• Licensed Practical Nurse in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Licensed Practical Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.